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| Social Work and the Mental Capacity Act |
| Email your comments The MCA offers an excellent way of advocacy in ensuring that people and their families are aware of advanced care planning. The Lasting Power of Attorney (LPA) is a feature of this process and offers safeguards to individuals and families who choose to express their wishes for future treatment and care. The Gold Standards Framework (GSF, 2007) offers a useful tool in the document, ‘Thinking ahead advanced care planning discussion’ and can be used as a means of initiating discussion. Exploration and understanding of such wishes can be challenging and relies heavily upon excellent communication skills and appropriate timing to ensure the process is helpful and sensitive. Social workers, particularly those working in palliative care, are well placed to initiate such discussions given their mix of skills and knowledge. The social worker should ensure that people and families have all available information, offering support where necessary to facilitate understanding of the process itself, as well as associated benefits and burdens. Social workers have a pivotal role in “best interests” decisions for those people who are no longer able to make decisions due to lack of capacity. They often have a pre-existing relationship with the person due to the nature of their involvement and the holistic focus of the social worker’s assessment. The nature and value of this relationship should be recognised by other professionals, as it should be by social workers themselves, who sometimes fail to see their contribution as valuable and unique. It is vital that social workers fully understand the MCA, in order to ensure that capacity is tested at appropriate times, and to prevent colleagues from making assumptions about previous capacity for different decisions. Social workers are skilled at leading the way in anti-discriminatory practice, safeguarding against discrimination by age or other circumstances (MCA, 2005); it is vital that this continues in order to ensure assumptions are not made. The Act goes beyond treatment decisions alone, to include other significant decisions such as moves into care and it requires the involvement of an Independent Mental Capacity Advocate (IMCA). Social workers have a duty to ensure that an IMCA is instructed when people are being moved into residential or nursing care and are ‘unbefriended’. This ensures that decisions are being made with the person’s best interests at the fore rather than sourcing the quickest solution aimed at the needs of the service rather than those of the individual. The active involvement of social workers in the MCA offers the opportunity for them to emphasise the importance of human rights and dignity regardless of levels of capacity. The challenge for social workers is to ensure that their knowledge and skills are up to date and to continue to negotiate their part in team working with other health and social care colleagues. This affords social workers the opportunity to be actively engaged in promoting best interests and ensuring individual rights in advance planning, advocacy and involvement by people at a particularly complex and vulnerable time in their life. Philippa Graham References 2. General Social Care Council (2002) Code of Conduct BGS Newsletter, May 2008 |